CERTIFICATE OF LIABILITY INSURANCE . DATE(MM/DD1YYYY)
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E3EPRESEIVTAT'!V�C���l�C4C3EJCF6�,ANE3 T'Fl ��RT'IFEAT'�lt�L� �.
IMPORTANT:
Ef the certificate hoCder!s an l E7E� AL! std £9,flee l�olicy(ies}must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement can this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Alley, Rehbaum & Capes Assurance, Inc. NAME: —_
727.797.5193
Aye No E — --- (arc r�aE_727_725.5773
2433 Gulf to Bay Blvd,
---.-- _.
. . ass[ 462E} ADDRESS_---- ----
Clearwater, FL 33758 ----- I NSURER(S)AFFORDING COVERAGE NAC
---
NsuRERA. Fmladelph-la Indemnity Ins Co
INSURED Artz 4 Life Acaders�y Irst — ...—_--_ -------- ----- — --------
INSURER B:
1606 N. Highland Acre ---------------— -- —.
ENSURER C,
Clearwater, FL 33755 — ------------- --
INSURER D.
INSURER E:
COVERAGES CERTIFICATE NUMBER: 12-13 V1 lON NUMBER:
THIS IS TO CERTIFY THAT THE POLECIES CDF INSURANCE LISTED EELOVI/HAVE BEEN ISSUED TC5 THE INSIJREED NAnflED ABOVE FOR 1'H F_POLECY FERICDD
INCICA"TED. NO'€ttVlTliSTAhdDING AhlY REQUERE(t�ENT TERM CDR COND(TIC)N OF ANY CONTF2AC7 OR OTHER LDOCUMEI`dT WITH RESPECT TO 1ttrHlCH THIS
CERTIFIC1iTE MAY QE ISSUED OR hfAY PERTAW,THE INSURANCE AFPCDRDED E3Y THE RC>LICiES DESCRIBED HEREIN IS SUBJECT 7O ALLTHE TEEMS,
E1.CLUSIONS ANC CONDITIONS OF SUCH POL{CIEs-LIMITS SHOWN MAY f4A1tE BEEN REDUCED BY PAID CLAEMS
LTR TYPE OE INSURANCE IhdSR WVD --- POLICY NUMBER — tatPRIDDtYYYY) -- --- ----------
GENERAL LIAB#LtYY (MMIDDNYYYj LIMITS
ptl1�K92288 10{01/2012 10/01/2013 EACH OCCURRENCE $ 1,000,000
COMMERCIAL GENERAL LIABILITY �--r--
PREMiSES tEa occurrence) `� 300,00
— --
CLAIMS-MADE OCCUR VIED EXP(Any one person) 5
.. _.._ _ -.. PERSONAL S.ADV INJURY 5 1,000,00
'-- - GENERAL AGGREGATE-- $ 3,000,00
GEN'L AGGREGATE LIMIT APPLIES PER � --
X POLICY PRO PRODUCTS-COMPIOP AGG 5 3,000,00
JECT LAC
AUTOMOBILE LIABILITY
S
ANYAUTC (Ea accident) $
SCH <i BODILY INJURY(Per person) $ALL C7'V�JNED ED LED _
AUTOS AUTO;, BODILY INJURY(Per accident) $
HiREDAUTOS NON-OWNED
AUTOS i 5C�L-tY 6At�Tv A�--` _�-------
(Peracci nf�--
UMBRELLA LIAB OCCUR
--
EXCESS LtA6 CLAIMS-MADE EACH OCCURRENCE $
— AGGREGATE $
RED RETENTION$ "-- --- -----.—_
WORKERS COMPENSATION w
AND EMPLOYERS'LIABILITY I- -YIN
TORY LtRttITS ER
ANY PERPREI'L7RIPARTNERtEXECIXTiVFr___1
OFFiGEWMEMBER EY.CLUDED? E i NIA E-L.EACH ACCIDENT $
(Mandatory in NH) ---------
If yes,describe under E.L_DISEASE-EA EMPLOYE- S
f DESCRIPTION OF OPERATIONS below —
—
EL.DISEASE-POLtC'YLtMIT $
DESCRIPTION OF OPERATIONS F LOCATIONS f VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
ertificate Holder is Additional Insurance
ocation: 1751 Icings Highway, Clearwater, FL 33755
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
�i
City of Clearwater AUTHORIZED REPRESENTATIVE
100 S. Myrtle Avenue
Cl crater, FL 33756 Si nature on file
1960-2416 A�C�f ll CORPORATION. All rights reserved.
ACORD 25(2010106) T he ACORD name and!ogle are registered marks of ACOR D